Search and selection criteria
This study was registered with the International Prospective Register of
Systematic Reviews (PROSPERO, http://www.crd.york.ac.uk/PROSPERO) as
CRD42019133045. We followed the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines to perform this review13. The
authors identified studies published in MEDLINE, EMBASE, LILACS, CENTRAL
and CINAHL databases, up to August 2019, using the terms “(((budesonide
OR ciclesonide OR mometasone OR beclomethasone OR flunisolide OR
fluticasone OR triamcinolone) AND (prednisone OR prednisolone OR
hydrocortisone OR methylprednisolone OR dexamethasone OR betamethasone)
AND (asthma exacerbations OR acute asthma OR acute wheezing OR wheezing
exacerbations)))”, filtered for children birth–18 yrs and clinical
trials; language restrictions were not applied.
To be included, studies had to meet all of the following criteria: 1)
children (preschoolers to adolescents) with asthma presenting with an
acute asthma in the ED or hospitalized 2) randomized clinical trials
(RCTs; parallel group or cross-over design) of any duration; 3)
comparison of ICS (by nebulizer or
MDI) plus SC (oral or parenteral) vs. placebo (or standard care)plus SC; and 4) a report of at least one of the following
outcomes: primary outcomes: hospital admission (for ED studies) or
hospital length of stay [LOS] (for hospitalized studies); and
secondary outcomes: asthma clinical score, readmissions during the
follow-up, ED-LOS, lung function, oxygen saturation
(SpO2), heart and respiratory rates, additional SABA
requirements, and drug-related adverse effects [AEs] or severe
adverse events [SAEs]. An SAE was defined as any untoward medical
occurrence that results in death, is life-threatening, requires
inpatient hospitalization, or results in persistent or significant
disability or incapacity14.
We excluded studies that only involved patients experiencing their first
wheezing episode or bronchiolitis and patients with other chronic
respiratory conditions (e.g. bronchopulmonary dysplasia, cystic
fibrosis, primary ciliary dyskinesia, and post-infectious bronchiolitis
obliterans) or congenital cardiopulmonary conditions.